REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR) s.s.

MUNICIPALITY OF TAGO)

AFFIDAVIT OF LOSS OF EMPLOYMENT ID CARD

I, ___________________, Filipino, of legal age, single, and a resident

of Purok Kasamahan, Dawis, Tandag City, Surigao del Sur, Philippines, after
having been duly sworn to in accordance with law, depose and state:

1. That I am holder of an Employment Identification Card issued by

MEGA Fishing Corporation based at Cagayan de Oro City, being
a former employee of the said company;

2. That said Identification Card was unfortunately lost and its

whereabouts cannot anymore be ascertained despite my diligent
search; and

3. That I am executing this Affidavit of Loss to attest to the veracity

of the foregoing and in support for the release of my unclaimed
wages at MEGA Fishing Corporation.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 9 th

day of January, 2017 at Tago, Surigao del Sur, Philippines.

__________________________
AFFIANT

SUBSCRIBED AND SWORN TO before me this 9th day of January,

2017 at Tago, Surigao del Sur, Philippines. The identity of the affiant is
established by his UMID with CRN-0111-2469734-3.